<div class="row-fluid">
    <div class="span0">
        <div class="alert alert-block alert-success fade in">
            <h4 class="alert-heading">Isikan data dengan benar</h4>
        </div>

        <div class="control-group">
            <?php echo form_open('psb/daftar'); ?>
            <label class="control-label" for="input01">Nama</label>
            <div class="controls">
                <input id="input01" class="input-xlarge span3" type="text" name="nama">
            </div>
            <label class="control-label" for="input01">Jenis Kelamin</label>
            <div class="controls">
                <select class="span2" name="sex">
                    <option value="Laki-laki">Laki-laki</option>
                    <option value="Perempuan">Perempuan</option>
                </select>
            </div>
            <label class="control-label" for="input01">Tempat Lahir</label>
            <div class="controls">
                <input id="input01" class="input-xlarge span3" type="text" name="tempat">
            </div>
            <label class="control-label" for="input01">Tanggal Lahir (1991-04-20)</label>
            <div class="controls">
                <input id="input01" class="input-xlarge span3" type="text" name="tgl">
            </div>
            <label class="control-label" for="input01">Sekolah Asal</label>
            <div class="controls">
                <input id="input01" class="input-xlarge span3" type="text" name="sekolah">
            </div>
            <label class="control-label" for="input01">Kabupaten Asal</label>
            <div class="controls">
                <input id="input01" class="input-xlarge span3" type="text" name="kabupaten">
            </div>
            <label class="control-label" for="input01">Nama Orang Tua</label>
            <div class="controls">
                <input id="input01" class="input-xlarge span3" type="text" name="ortu">
            </div>
            <label class="control-label" for="input01">Nilai</label>
            <div class="controls">
                <input id="input01" class="input-xlarge span3" type="text" name="nilai">
            </div>
            <p class="help-block">Ketikkan data di kolom di atas.</p>
            <button class="btn btn-info" href="#"><i class="icon-pencil icon-white"></i> Daftar</button>
            <?php echo form_close() ?>
        </div>
    </div>
</div>